More bowel problems

Question 1

What are the causes of ischemic colitis?

Answer 1

lupus, atherosclerosis, embolus, global ischemia/inadequate systemic perfusion

Question 2

How is ischemia to different parts of the bowel different?

Answer 2

-small bowel ischemia has pain out of proportion to the exam; large bowel ischemia tends to be less severe. left colon is most commonly involved; rectum is spared due to collateral circulation

Question 3

What is the time-course for post-op ileus?

Answer 3

-usually lasts less than 5 days. small bowel recovers in 24 hrs, stomach in 2-3 days, and large bowel in 3-5 days

Question 4

What are the radiographic signs of volvulus?

Answer 4

double bubble proximal and distal to volvulus on AXR, barium enema shows bird’s beak for distal volvulus

Question 5

What is the treatment for volvulus?

Answer 5

colonoscopic decompression of sigmoid volvulus; surgical repair or resection in cecal volvuls or failed cononscopic detorsion

Question 6

What is the most common cause of acute lower GI bleeding in patients over 40?

Answer 6

diverticular disease

Question 7

How is mild diverticulitis treated?

Answer 7

if no perforation and early, do bowel rest and PO abx- fluroquinolone and metronidazole, TMP-SMX and metronidazole, or amoxicillin-clavulonate

Question 8

What are complications of diverticulitis?

Answer 8

abscess, fistula, sepsis

Question 9

What is the treatment for severe diverticulitis?

Answer 9

resect colong and remove any obstruction or fistula. may need colostomy if peritonitis, with reanastamosis at 3 months

Question 10

Which hemorroids are painful?

Answer 10

external hemorrhoids (of the inferior rectal vein)

Question 11

What are the treatments for anal fissures?

Answer 11

stool softeners, topical nitroglycerin, parital sphincterotomy if recurrent

Question 12

What kinds of cells give rise to carcinoid tumors? Where are the tumors located?

Answer 12

• neuroectodermal cells
• usually in bronchopulmonary tree, ileum, rectum or appendix
• secrete serotonin

Question 13

What is carcinoid syndrome? How is it diagnosed?

Answer 13

• flushing, diarrhea, bronchoconstriction, tricuspid and pulmonary valvular disease due to serotonin secretion by the tumor in cases where there are liver mets or extraGI involvement.
• detect with high serum serotonin and high urniary 5-HIAA

Question 14

What further work-up should be done for carcinoid syndrome?

Answer 14

-CT or indium labeled octreotide scintigraphy to find the tumor

Question 15

What is the tx for carcinoid tumor?

Answer 15

If less than 2 cm, resect
if more than 2 cm, there is a high risk of mets. extensive resection, and treatment with IFN-alpha, octreotide and embolization

Question 16

Where does colon cancer metastasize to?

Answer 16

lung and liver

Question 17

What is the general approach to colon cancer treatment?

Answer 17

surgical resection with adjuvant chemo if nodes are positive

Question 18

What is gardner syndrome?

Answer 18

similar to FAP but also have bone and soft tissue tumors

Question 19

What is juvenile polyposis?

Answer 19

polyps of colon, small bowel and stomach that are often a source of GI bleeding. there is a slightly increased risk of malignancy in later life

Question 20

What are the key causes of upper GI bleed?

Answer 20

PUD, esophageal varices, gastritis, esophagitis, mallory weis tear

Question 21

What is the acute treatment for an upper GI bleed?

Answer 21

PPI for upper GI bleed until gastric cause can be ruled out. prophylactic antibiotics (IV cephalosporin) and BB if pt has known cirrhosis. sclerotherapy may also help stop bleeds from varices.

Question 22

What treatment can be offered if pt has bleeding from AVM or diverticula?

Answer 22

vasopressin